Change of Dismissal
Change of Dismissal
Today's Date
Today's Date
*
/
MM
/
DD
YYYY
Student Name
Student Name
*
First
Last
Student's Grade Level
*
KG
1st
2nd
3rd
4th
5th
SBCP Puffins
Beginning Date
Beginning Date
*
/
MM
/
DD
YYYY
Last Day of Dismissal Change (if only one day put the same date)
Last Day of Dismissal Change (if only one day put the same date)
*
/
MM
/
DD
YYYY
Check here if this is a permanent change
Check here if this is a permanent change
Yes, this is a permanent change.
Anything else we need to know.
Student's Normal Dismissal Method
*
Bus rider **Must have bus pass issued by transportation dept.
Walker/Biker
Car rider
Daycare Van
PLACE
Please select One
Daycare Van name if applicable
New Dismissal
*
Bus Rider ** Must have bus pass issued from Transportation Dept.
Walker/Biker
Car rider
Daycare Van
PLACE
My child will DEPART from school in the following manner: Please select One
Name of Person Requesting Change
*
Email
*
Contact Number for Questions
Contact Number for Questions
*
-
###
-
###
####
No changes are permitted after 2:00pm for same day dismissal change
*
No changes are permitted after 2:00pm for same day dismissal change
I am aware that changes made after 2:00pm for same day will NOT be honored.
IMPORTANT: We will not accept a verbal message from the child. If for any reason you need to pick up your child(ren) early, the latest pick up time is 3:00pm.
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